1. Effect of incomplete reperfusion patterns on clinical outcome: insights from the ESCAPE-NA1 trial.
- Author
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Cimflova, Petra, Singh, Nishita, Kappelhof, Manon, Ospel, Johanna M., Sehgal, Arshia, Kashani, Nima, Almekhlafi, Mohammed A., Demchuk, Andrew M., Berrouschot, Joerg, Dorn, Franziska, Kelly, Michael E., Buck, Brian H., Field, Thalia S., Dowlatshahi, Dariush, Tymianski, Michael, Hill, Michael D., and Goya, Mayank
- Subjects
MYOCARDIAL infarction ,ACUTE diseases ,ISCHEMIA ,THROMBOLYTIC therapy ,RESEARCH funding ,STATISTICAL sampling ,TREATMENT effectiveness ,RANDOMIZED controlled trials ,ANGIOGRAPHY ,DESCRIPTIVE statistics ,LONGITUDINAL method ,ODDS ratio ,ISCHEMIC stroke ,RESEARCH ,REPERFUSION ,THROMBECTOMY ,CEREBRAL infarction ,COMPARATIVE studies ,CONFIDENCE intervals ,DISEASE incidence - Abstract
Background Incomplete reperfusion (IR) after mechanical thrombectomy (MT) can be a consequence of residual occlusion, no-reflow phenomenon, or collateral counterpressure. Data on the impact of these phenomena on clinical outcome are limited. Methods Patients from the ESCAPE-NA1 trial with IR (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b) were compared with those with complete or near-complete reperfusion (eTICI 2c-3) on the final angiography run. Final runs were assessed for (a) an MT-accessible occlusion, or (b) a non-MT-accessible occlusion pattern. The primary clinical outcome was modified Rankin Scale (mRS) 0--2 at 90 days. Our imaging outcome was infarction in IR territory on follow-up imaging. Unadjusted and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (95% CI) were obtained. Results Of 1105 patients, 443 (40.1%) with IR and 506 (46.1%) with complete or near-complete reperfusion were included. An MT-accessible occlusion was identified in 147/443 patients (33.2%) and a non-MT-accessible occlusion in 296/443 (66.8%). As compared with patients with near-complete/complete reperfusion, patients with IR had significantly lower chances of achieving mRS 0--2 at 90 days (aIRR 0.82, 95% CI 0.74 to 0.91). Rates of mRS 0--2 were lower in the MT-accessible occlusion group as compared with the non-MT-accessible occlusion pattern group (aIRR 0.71, 95% CI 0.60 to 0.83, and aIRR 0.89, 95% CI 0.81 to 0.98, respectively). More patients with MT-accessible occlusion patterns developed infarcts in the non-reperfused territory as compared with patients with non-MT occlusion patterns (68.7% vs 46.3%). Conclusion IR was associated with worse clinical outcomes than near-complete/complete reperfusion. Two-thirds of our patients with IR had non-MT-accessible occlusion patterns which were associated with better clinical and imaging outcomes compared with those with MT-accessible occlusion patterns. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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